This month, I’ll be discussing Electronic Medical Record (EMR) adoption with a group of thought leaders and policymakers at the forefront of the Canadian health care system.  The problem of EMR adoption – where Canada currently ranks last among the G7 Countries -- is one I tackled at the office of U.S. National Coordinator for Health IT from 2009 through 2013.

The Recovery Act provided some $30 billion (USD) in incentive payments for doctors and hospitals that met ambitious standards for “meaningful use” of certified EMRs, and another $2B in federal funding for activities that supported technical assistance, interoperability standards, research, and training.

The program worked. Before the program, only 9% of hospitals and 17% of outpatient doctors used EMRs for basic clinical tasks. Within 4 years, 84% of eligible hospitals and 52% of eligible professionals earned incentive payments for adoption and meaningful use of EMRs. To take one metric among many, the use of EMRs to electronically prescribe medications directly to pharmacies exploded from 8% to over 80%.

The journey in the US is far from over; information sharing is still limited, and the EMR has become a lightning rod for many of the ills of a fragmented health care system. But many of my colleagues North of the border have asked a simple question: What can Canada learn from our experience?

Adoption of technology is not enough.

To reap the full benefit of EMRs, physicians and hospitals must have reason to use them to their full capacity, and to share information. As we said at the time, owning a piano isn’t enough to make beautiful music.  First, the keys and chords must be standard.  So we established consistent federal criteria for minimum functionalities of eligible EMRs.  More importantly, we created incentives for physician offices and hospitals to practice advanced capabilities – like clinical reminders. But most important of all are new compensation models and broader incentives for the health care system to play together- to achieve better patient outcomes, not just more billed visits, tests, procedures, and hospitalizations- regardless of quality, safety, or necessity.

Small practices need helping hands.

92% of medical offices in Canada have fewer than 6 physicians; smaller offices are less likely to invest in EMRs.In addition to financial assistance, meaningful adoption of technology in small and rural practices will require hands-on training and support. The US created a Health IT Extension Program that delivered subsidized technical assistance to these practices, and ensured that a digital divide did not widen.

Patients want- and deserve- access to their own health records.

Digital records can be shared in a way that paper charts simply can’t. The mobile and internet technology that has revolutionized how we live our daily lives can do miracles for personalizing our health and health care - but it runs on digital information. Government regulations and enforcement are needed to ensure that patients (and those they designate) can take ownership over their digital health data online - a concept we called “the Blue Button.” At the same time, private sector innovation is needed to use this data to create consumer-facing health technology products that empower, inform, and perhaps even entertain us on the way to better health and health care.

Usability matters.

While yesterday’s technologies can still be very effective in the right hands, today’s mobile and cloud-based technologies are more secure, easier to keep up to date, and simpler to use. Government shouldn’t try to regulate usability or centralize technology procurement for doctors and hospitals, but should work with them to make sure that there is a vibrant and competitive EMR industry that values usability and information sharing.

The United States has made dramatic progress in making EMRs integral to every doctor’s practice, though many challenges remain. Canada can build on the lessons of the US experience to achieve even better results with a comprehensive approach.

About the Author

Farzad Mostashari, MD is the CEO of Aledade, a company which partners with American primary care physicians to form Accountable Care Organizations – networks of providers dedicated to keeping patients healthy. He was formerly the National Coordinator for Health IT at the United States Department of Health and Human Services